Balancing the value and risk of exercise-based therapy post-COVID-19: a narrative review, 2023, Singh, Chalder et al.

Balancing the value and risk of exercise-based therapy post-COVID-19: a narrative review
Sally J. Singh; Enya Daynes; Hamish J.C. McAuley; Betty Raman; Neil J. Greening; Trudie Chalder; Omer Elneima; Rachael A. Evans; Charlotte E. Bolton

Coronavirus disease 2019 (COVID-19) can lead to ongoing symptoms such as breathlessness, fatigue and muscle pain, which can have a substantial impact on an individual. Exercise-based rehabilitation programmes have proven beneficial in many long-term conditions that share similar symptoms. These programmes have favourably influenced breathlessness, fatigue and pain, while also increasing functional capacity. Exercise-based rehabilitation may benefit those with ongoing symptoms following COVID-19.

However, some precautions may be necessary prior to embarking on an exercise programme. Areas of concern include ongoing complex lung pathologies, such as fibrosis, cardiovascular abnormalities and fatigue, and concerns regarding post-exertional symptom exacerbation.

This article addresses these concerns and proposes that an individually prescribed, symptom-titrated exercise-based intervention may be of value to individuals following infection with severe acute respiratory syndrome coronavirus 2.


Link | PDF (European Respiratory Review)

 

[85] Myopathy as a cause of fatigue in long-term post-COVID-19 symptoms: Evidence of skeletal muscle histopathology (2022, European Journal of Neurology)

The word "deconditioning" does not appear in that reference. Instead it states —

 

[93] is Exercise therapy for chronic fatigue syndrome (2019, Cochrane Database of Systematic Reviews)

 

[98] is Development of a fatigue scale (1993, Journal of Psychosomatic Research)

I presume this is an error in the reference and they intended [97] Adverse outcomes in trials of graded exercise therapy for adult patients with chronic fatigue syndrome (2021, Journal of Psychosomatic Research)

Similarly [97] should probably be [96] Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome PACE: a randomised trial (2011, The Lancet)

 

I don't know which reference 109 is supposed to mean, take your pick from those in proximity —

Regardless, deconditioning has been shown to be specifically not the cause of exercise intolerance in long Covid. See Differential Cardiopulmonary Hemodynamic Phenotypes in PASC Related Exercise Intolerance (2023, ERJ Open Research). Deconditioning through bed rest studies does not decrease peripheral oxygen extraction. Deconditioning results in decreased peak cardiac output and LC patients had supranormal peak cardiac output. They are the opposite of deconditioned.

 

Plain English summary:
Re-balancing the value and risk of exercise-based therapy post-COVID-19: a tall story -view.

 

It looks like something has gone seriously awry with the reference citations.

Todd has also spotted it.
https://twitter.com/user/status/1738163205560774980


I suspect he'll have more to say in the morning.

 

This is a great example of why after almost 4 years of this exact model, there has been zero progress in Long Covid. This is the current model, applied for nearly 4 years onto millions of people. It's widely acknowledged that there are no effective treatments for Long Covid, and here they come along, suggesting it "may be of value", based on fully debunked assumptions like deconditioning and a complete lack of evidence for it.

There is really no need to look further as to why there is no progress, why it takes decades for medical treatments to become accessible to patients. It's accepting being stuck in a state of failure, perpetuated for absolutely no discernible reason, decade after decade of insisting against all evidence while calling it "evidence-based".

The problem isn't people like Chalder and other people involved in this. It's that this way of doing things isn't just accepted, it's demanded. Using basic common sense and lizard-brain reasoning alone, there is no need for evidence here. This is the current treatment paradigm. It has been a massive failure. Yet again, for 4 more years. But somehow it can be suggested as something that "may be of value", and that reaffirms how it's the right way. Even though it's a failure. There isn't even a need for evidence

Yesterday I saw someone share a notice from the LC clinic that it's closing down because GPs can now effectively treat most symptoms so there's no need for specialists. Reality just doesn't factor in here, it's either fully delusional, or blatant lying, or both. But in reality it's even worse, it's simply not caring, because it doesn't matter. Almost none of this gets properly recorded anyway, so it's like a police department not recording certain crimes and giving themselves credit and bonuses for it. It's an insane system that has no chance of producing anything of value anywhere, least of all in health care, but here it's demanded. It has to be that, there is no desire to do anything more. Lest it exposes just how little medicine really knows about health and illness.

A system that values performative failure more than it cares about its primary mission. It's just not believable that this problem doesn't affect and degrade everything it does. This is simply not normal. It's normal human behavior not to care when there are no stakes, but that there are no stakes is what's abnormal. It's an aristocratic model, where the people who make the decisions don't owe anything to anyone, and can always choose what they prefer, regardless of outcomes.

There is really no profession in greater need of being revolutionized by AI than medicine. Nowhere else sees that kind of failure, where basic stuff is failed again and again and nothing changes. It does worse at the basic stuff, and best at pushing the cutting edge. It's just built wrong.

 

It does suggest that it's not significant though .
Big cue for more behavioural nonsense.

 

But replaced with the LC version of CBT/ GE which is breathing exercises with a Respiratory Nurse My LC refers everyone to her and she diagnoses every single person with 'disordered breathing'. Then she sees them for x number of months.

The Respiratory Nurse had no experience in this area pre Covid. She tried to diagnose me with 'disordered' breathing until I showed her that I already knew all the exercises from previous bad experience in that area.

Problem is the LC people want to see her and are desperate for help. They eventually get churned out the other end having spontaneously recovered or are just as bad after. It's CBT all over again.